House GOP seeks Medicaid flexibility

Updated 1:20 am, Tuesday, March 5, 2013

AUSTIN — Texas House Republicans voted to oppose expanding Medicaid under the federal health care law's current strictures Monday, but leaders said talks continue on how to cover more uninsured people with the hope of flexibility from the feds.

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GOP lawmakers stressed that vigorous discussions are under way about how to craft a solution that would make health coverage available to uninsured Texans.

Some are pointing to the federal government's decision to allow Arkansas to use Medicaid money to buy private health insurance for poor people. Some have floated the prospect of co-pays or charging a premium to Medicaid recipients.

Among ideas in the mix, Creighton said, is giving a franchise-tax break to businesses that continue to offer health care coverage.

Rep. John Zerwas, a Simonton Republican who oversees human services issues on the House Appropriations Committee, said that “the devil's in the details” but the Arkansas plan could be one framework for Texas to examine.

“We're not just saying we're not going to expand Medicaid,” Zerwas said. “What we're saying is we're not going to expand Medicaid if we have to live by the federal rules, which clearly make this a difficult program to work with.”

The Medicaid expansion offered to states under the federal health care law would cover low-income adults who aren't covered by the traditional program. In Texas, more than 1 million additional Texans would be newly eligible.

The federal government would pay for expanding services for the first three years, with the state picking up administrative costs. After three years, states would pick up an increasing share of the cost of services, capped at 10 percent.

The Health and Human Services Commission estimates the 10-year state cost would be $15.6 billion, drawing $100 billion in federal funds.

Advocates of expansion, including health care providers and local officials, say it would ensure more people have health care before resorting to expensive emergency room visits. They also say it would be a relief to taxpayers and insured people who now must absorb the cost of care for uninsured patients.

Republicans including Gov. Rick Perry, however, have stood firm in saying they consider it foolhardy to put more money into Medicaid as it exists, calling it a broken system that is taking an ever-increasing share of the state government's budget.

Rep. Lyle Larson, R-San Antonio, said Republicans must weigh political and business perspectives in deciding on Medicaid expansion. He said, it's still a “bitter pill” for many Republicans in “accepting the fact that the president won.”

“We need to reconcile the political decision with the business decision like the recent announcements by governors in New Jersey, Florida and Arizona,” he said. “Taking a credit card from your broke uncle isn't sustainable, but we must determine how to go about this without losing billions that we've sent to the federal government.”

Larson said he was meeting with constituents and unable to attend the caucus meeting.

On the other side of the Capitol, Senate Finance Committee Chairman Tommy Williams, R-The Woodlands, has put forth several potential elements of a Texas-style Medicaid program, including co-pays and deductibles, managed-care expansion and requiring individuals to enroll in available private or employer plans.

Health and Human Services Committee Chairwoman Jane Nelson, R-Flower Mound, pointed to a Senate Finance Committee vote to put $200 million in state general revenue into mental health services. She suggested the prospect of finding a way to use Medicaid dollars to allow people who need those services to instead buy into an insurance plan.

“I have said for a long time that I oppose expansion unless we are given the flexibility to do things our way,” Nelson said.